Reduction In Duration Of Post-Operative Urinary Catheters Following Implementation Of An Electronic Reminder System

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Issue

The risk of catheter-associated urinary tract infection (CAUTI) increases each day that the indwelling urinary catheter remains in place. Reduced duration of indwelling urinary catheter use is an important strategy to reduce CAUTI. Through process measurement, we determined that we had poor compliance with prompt removal of indwelling urinary catheters from surgical inpatients.

Project

Our private non-profit community non-teaching 166 bed acute care California hospital serves medical-surgical, oncology, family birthing, level II nursery, and critical care including open heart surgery patients. 799 Surgical Care Improvement Project (SCIP) procedure cases were studied for this project and included total hip and knee replacements, abdominal hysterectomy, vascular cases, colon cases, coronary artery bypass graft cases, and other cardiac surgery cases, e.g. valvular surgery. Our

Results

1) Compliance with removal of indwelling urinary catheters from the selected population on post-operative day one or two, without any intervention, was 47.1% (104 surgical procedures). 2) Compliance after education rose from 47.1% to 64.3%, and fell to approximately 50.0% for a sustained period (486 surgical procedures). 3) Compliance after use of the electronic reminder reached 81.0% after two quarters (209 surgical procedures).

Lesson Learned

1) An electronic reminder displayed to the orthopedic and general surgeons when opening the patient's electronic chart provided the greatest improvement from 47% baseline compliance to 81% post-intervention compliance. 2) Expanded use of this method beyond the SCIP cases may further reduce the risk of CAUTI, and is planned for 2012. 3) Continue to integrate education to involve nurses in best practices during catheter insertion, maintenance, and working in an advocate role for patient safety

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